Immediate physical therapy is beneficial for adolescent athletes with active lumbar spondylolysis: a multicentre randomised trial

Abstract

Objectives: To compare the effects of initiating physical therapy (PT) immediately versus resting before starting PT on pain and dysfunction over 12 months in adolescent athletes (10-19 years) with active lumbar spondylolysis.

Methods: This prospective multicentre trial randomised participants to immediate PT or rest before PT. The immediate PT group began PT within 7 days and progressed based on pain and function. The rest before PT group started PT once symptoms resolved and progressed based on time. The primary outcome was pain and disability (Micheli Functional Scale) between groups over time, measured at baseline, 1 (primary end point), 3 and 12 months. Time to return to sport and the recurrence rate of low back pain (LBP) were also assessed. Outcomes were analysed using an intention-to-treat approach.

Results: Sixty-four participants (median age 14.2 years; 40% female) were randomised to immediate PT (n=30) and rest before PT (n=34). At 1 month, the immediate PT group showed significant improvements in pain and disability (mean difference on Micheli Functional Scale of 21.3, 95% CI 28.7 to 13.9; p<0.001). They also returned to sport 38 days sooner (p<0.001), with fewer recurrences of LBP over 12 months (3% vs 29%; p=0.01). There were no adverse events.

Conclusions: Clinicians may consider prescribing PT immediately after diagnosing active lumbar spondylolysis instead of rest. Immediate PT showed greater initial improvements in pain and dysfunction, a quicker return to sport and a lower recurrence of LBP compared with rest before PT among adolescent athletes with spondylolysis.

Trial registration number: NCT05505981.

Keywords: adolescent; athletes; spine.